Stress Questionnaire Directions: In the blank in front of each item, write the number that best indicates how intense of stress that item is for you. Add additional items to the end if needed. Remember to keep this questionnaire. You will need it for the rest of the workshops. Stress Intensity Ratings 0 = Not at all 1 = Somewhat 2 = Moderate 3 = Severe _____ Health problem or injury of myself or family member _____ Too much to do or long work hours _____ Machinery breakdown or stock problem _____ Purchased new machinery, building, or land _____ Crop or stock loss _____ Unreliable prices for the products I raise _____ Handling pesticide _____ Financial difficulties in my farm or business, including too much debt _____ Problems with government regulations, legal issues, or bank _____ Not enough money for family needs _____ Dealing with the weather _____ Conflict with operating partner or farm help _____ Conflict with my spouse or life partner _____ Conflict with my kids _____ Difficulties with relatives, including in-laws _____ Helping an older relative with health or home management _____ Conflicts with friends or neighbors _____ Difficulty getting or keeping a job or second job, or job conflicts _____ No one to talk with about my troubles _____ Not enough time to do the farm/or job things I want to do _____ Too little time for my family _____ Not enough hobbies, recreation, and entertainment _____ Too much time on my hands in some seasons _____ Dealing with recent death of someone close to me _____ Dealing with Divorce or separation _____ Pregnancy or recent birth in our family _____ Change in living situation, including child growing up and moving out _____ Marriage, big personal achievement, etc. _____ Promotion, retirement, or job changes _____ Other stress:_______________________________________ _____ Other stress:_______________________________________ _____ Other stress:_______________________________________ _____ TOTAL Total Stress Intensity Levels High = 30 and higher Medium = 15-29 Low = 14 and under Developed by Kay Slama, Ph.D. (June 2009) for the Dealing with Stress: Web-based Educational Series. Visit www.extension.umn.edu/ToughTimes/dealing-with-stress.html for more information. This has been adapted from Holmes & Rahe’s (1967) Holmes-Rahe life changes scale (Journal of Psychosomatic Research, 11, 213-218, Elsevier).
Pages to are hidden for
"Questionnaire on Stress Management - PDF - PDF"Please download to view full document